Elsevier

Critical Care Clinics

Volume 24, Issue 2, April 2008, Pages 421-442
Critical Care Clinics

Antibiotic Adverse Reactions and Drug Interactions

https://doi.org/10.1016/j.ccc.2007.12.011Get rights and content

When contemplating antibiotic use, intensivists must consider possible beneficial and harmful drug interactions. After antibiotics are instituted, adverse reactions must be anticipated. Acute illness, comorbidities, and concurrent medications affect the presentation and management of antibiotic-related adverse events. Intensivists should use the fewest possible antibiotics, carefully choosing agents that maximize antimicrobial activity and minimize potential drug interactions and adverse reactions.

Section snippets

Anaphylaxis

Anaphylaxis is an acute hypersensitivity reaction that can result in immediate urticaria, laryngospasm, bronchospasm, hypotension, and death. In the critical care setting, these reactions may be masked by underlying conditions or other therapies. While anaphylaxis can be precipitated by antigen-antibody complexes, it is usually IgE mediated. The binding of antibiotic epitopes to specific preformed IgE antibodies on the surface of mast cells results in the release of histamine and other

Drug interactions

The remainder of this article discusses important potential interactions amongst antibiotics and between antibiotics and other medications. Antibiotics can either be the precipitant or the object of a drug interaction. Interactions can be beneficial or harmful. This section addresses beneficial interactions before focusing on interactions that can result in adverse events.

Summary

Antibiotics are commonly used in the ICU. Adverse effects are regularly encountered and must be anticipated. The multiplicity of medications and underlying conditions in ICU patients affect the presentation and management of adverse reactions. When possible, the intensivist should employ the fewest number of antibiotics necessary, choosing those least likely to interact with other drugs and cause adverse reactions.

Acknowledgments

The authors gratefully acknowledge intensivists Lori Circeo, Thomas Higgins, Paul Jodka, and especially Gary Tereso for helping us identify the most important adverse reactions and drug interactions affecting critically ill patients. The authors also gratefully acknowledge Pauline Blair for her excellent assistance in preparing this review.

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  • Cited by (0)

    This article was adapted from Granowitz EV, Brown RB. Adverse reactions to antibiotics. In: Cunha BA, editor. Infectious diseases in critical care medicine, 2nd edition. New York: Informa Healthcare USA, Inc.; 2007. p. 575–94; with permission.

    1

    Dr. Brown is on speakers' bureaus of Merck, Ortho, Pfizer, and Cubist pharmaceuticals.

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